Objectives:To determine whether co-location of primary and specialty care within the VHA was associated with a more informed or active decision-making role for primary care in cancer care delivery.

Methods:Mail survey completed by 1,409 Veterans (67% response rate) between August-November 2009 receiving a diagnosis of colorectal cancer at any VA facility in 2008 as ascertained by the VA Central Cancer Registry.

Results:56% of Veterans saw their primary care physician (PCP) at the same VA facility as their treating specialist (oncologist, surgeon), 38% saw their PCP at a different VA facility than their specialist, and 5% had a non-VA PCP. Veterans reported no difference in how “informed and up-to-date” their PCP seemed when their PCP practiced at the same or different VA facility as their specialist; however, fewer Veterans seeing a non-VA PCP reported their PCP “always” seemed up-to-date about the care delivered for cancer-related problems (31% vs. 61%, chi-squared, p <0.001). Veterans seeing their PCP at the same VA facility as their specialist significantly more often reported their PCP (a) told them about cancer treatments (50%), or (b) helped them decide what treatment to have (44%), compared to Veterans seeing their PCP at a different VA facility (40% or 33%), or a non-VA PCP (24% or 25%).

Implications:Electronic medical record integration may explain why Veterans perceived their PCP to have the same informational awareness about their cancer care, whether their PCP was located at the same or different VA facility than their cancer physician. However, when Veterans saw their PCP at the same VA facility as their specialist, the PCP had a more active decision-making role, perhaps due to informal communication facilitated by geographic proximity between the PCP and treating physician(s). Non-VA PCP physicians were the least aware and involved in the care of their cancer patients.

Impacts:The VA Office of Specialty Care Services is implementing new programs to promote primary-specialty care coordination. In developing these models, policymakers should focus less upon information-sharing needs and more upon the promotion of professional relationship-building. However, direct information exchange may be necessary to make non-VA PCPs more informed about care received by Veterans.